Definition of Benign Paroxysmal Positional Vertigo

Individuals with vertigo incorrectly experience motion (often a spinning motion) in their surroundings. The feelings of vertigo occasionally include dizziness, falling or spinning. When vertigo impacts balance, it may lead to falls and injuries – particularly among the elderly. More serious cases of vertigo may also trigger vomiting, nausea, migraines, fainting and visual abnormalities known as nystagmus.

There can be many causes for vertigo, but one form of it – benign paroxysmal positional vertigo, abbreviated BPPV – is related to your sense of hearing. Benign paroxysmal positional vertigo is caused by calcium crystals that form naturally in the inner ear called otoconia or otoliths, and which normally cause no issues. In BPPV, the crystals migrate from their normal locations into the semicircular canals of the inner ear. Once inside the semicircular canals, the crystals trigger an abnormal displacement of endolymph fluid whenever a person alters the position of their head (relative to gravity). This is the root cause of the vertigo feelings in cases of BPPV.

Everyday motions such as tilting your head, looking up and down or rolling over in bed can bring about the BPPV. The vertigo sensation comes on very suddenly and has a short duration. The resulting vertigo can be worsened by stress, sleep disorders, or changes in barometric pressure (for instance, in advance of a snowfall or rainfall). Although BPPV can begin at any age, it is more common in individuals over 60 years old. The initial trigger for the BPPV is generally hard to pinpoint. A sudden blow to the head (for example in a car accident) is among the more well-known causes.

Benign paroxysmal positional vertigo is differentiated from other forms of vertigo or dizziness in that it is almost always prompted by head movements, and in that its symptoms usually decrease in in under a minute. Diagnosing BPPV typically involves a straightforward test where the patient lies on an exam table and tilts their head to the side or over the edge. Additional tests which can be used to diagnose benign paroxysmal positional vertigo include electronystagmography (ENG) or videonystagmography (VNG), which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to eliminate other possible causes, such as brain tumors or brain abnormalities.

The most common treatment for BPPV is canalith repositioning, such as the Epley maneuver and the Semont maneuver, both of which are a sequence of physical motions used to shift the crystals to an area of the inner ear in which they no longer cause trouble. Surgery is an option in the exceptional cases where these treatment methods are ineffective. If you have encountered inexplicable dizziness or vertigo that lasts for more than a week, see your doctor.